Mechanisms and Utility of Discrete Great Arterial Potentials in the Ablation of Outflow Tract Ventricular Arrhythmias
Mechanisms and Utility of Discrete Great Arterial Potentials in the Ablation of Outflow Tract Ventricular Arrhythmias
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DOI：
10.1161/circep.107.750315
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发表时间：
2008-04-01
影响因子：
8.4
通讯作者：
Shen, Win-Kuang
中科院分区：
文献类型：
--
作者：
Srivathsan, Komandoor S.;Bunch, T. Jared;Shen, Win-Kuang
背景--起源于半月瓣上方的流出道室性心动过速在少数研究中已有报道。在接受电生理评估和射频消融治疗室性心律失常的患者中，大动脉(半月瓣上方)的离散电位很少被描述。这些离散电位在大动脉中的作用机制及其对射频消融的指导作用尚不清楚。方法与结果--12例起源于半月瓣以上的流出道室性心律失常患者均有离散动脉电位。对其临床特点、动脉电位的特点、电生理评估和消融以及近期和远期疗效进行了综述。在12名患者中，8名(67%)是女性。患者平均年龄为41+/-14岁。平均射血分数为0.52+/-0.16(0.16~0.75)。所有患者的大动脉接触标测均显示了独立的近场电信号和远场脑室电信号(其中8例位于肺动脉瓣上方，4例位于主动脉瓣之上)。在12例患者中有10例观察到一种或多种支持致心律失常底物的电生理特征：(1)基线或起搏时存在一种固定的或可重复变化的离散电位-室性心律失常关系；(2)窦性心律时离散电位-室性心律失常的关系与室性心律失常时相反；(3)在持续性室性心动过速期间，室性(V-V)周期长度的自发变化之前，动脉峰电位-峰电位周期长度的变化类似；(4)离散动脉电位引导消融成功地消除了临床心律失常。这些患者消融成功。在其余2名患者中，潜在的可能性被认为是旁观者。随访10+/-4个月(5~32个月)，未见室性早搏或室性心律失常复发。结论：部分流出道室性心动过速患者的大动脉存在离散电位。当一种致心律失常的关系能够被证明时。离散电位在指导大血管内消融方面是有用的，尽管存在显著的解剖复杂性。(中国保监会)心律失常电生理。2008；1：30-38。)
Background-Outflow tract ventricular tachycardia originating above the semilunar valves has been reported in a small number Of Studies. Discrete potentials in the great arteries (above the semilunar valves) have been rarely described in patients Undergoing electrophysiology evaluation and radiofrequency ablation for ventricular arrhythmias. The mechanisms of these discrete potentials in the great arteries and the utility of such potentials in guiding radiofrequency ablation are unknown.Methods and Results-Twelve patients with outflow tract ventricular arrhythmia originating above the semilunar valves with discrete arterial potentials were studied. The clinical characteristics, properties of the arterial potentials, electrophysiological evaluation and ablation, and short- and long-term Outcomes were reviewed. Of the twelve patients, 8 (67%) were women. The patients' average age was 41 +/- 14 years. The average ejection fraction was 0.52 +/- 0.16 (range: 0.16 to 0.75). Contact mapping in the great artery demonstrated discrete near-field electrograms that were separate from far-field ventricular electrograms in all patients (8 above the pulmonary valve and in 4 the aortic valve). One or more of the following electrophysiological characteristics, supportive of an arrhythmogenic Substrate, were observed in 10 of 12 patients: (1) A fixed or reproducibly variable pattern of discrete potential-ventricular arrhythmia relationship was present at baseline or during pacing (2) the discrete potential-ventricular electrogram relationship during sinus rhythm was the reverse of that during the ventricular arrhythmia (3) during sustained ventricular tachycardia, spontaneous variation of the ventricular (V-V) cycle length was preceded by a similar variation of arterial spike potential-spike potential cycle length and (4) ablation guided by the discrete arterial potential successfully eliminated the clinical arrhythmia. Ablation was Successful in these patients. In the remaining 2 patients, the potentials were believed to be bystanders. Over 10 +/- 4 months (range: 5 to 32 months) of follow-up, there have been no recurrences of the premature ventricular complex Or ventricular arrhythmia.Conclusions-Discrete potentials are present in the great arteries of a select group of patients with outflow tract ventricular tachycardia originating above the semilunar valves. When an arrhythmogenic relationship can be demonstrated. discrete potentials are useful in guiding ablation within the great vessels, despite significant anatomic complexity. (Circ Arrhythmia Electrophysiol. 2008;1:30-38.)